Ask an expert - muscles and bones - hypermobility

4 questions

We have had several questions about Ehlers Danlos syndrome, possibly reflecting the fact that it is one of a number of conditions for which conventional medicine cannot provide a solution. Our first answer back in February remains largely the essence of what we would say, namely:

How can accupuncture help EDS?

Ehlers-Danlos Syndrome is one of a number of genetic connective tissue disorders which manifest in a wide array of symptoms and as congenital degenerative conditions are not likely to change or improve. In these circumstances the best that one could hope to achieve with acupuncture would be to relieve some of the symptoms which are manifesting your particular case, and perhaps to slow down the progressive deterioration.

There have been attempts to use acupuncture as part of a package of measures to help people deal with the condition, but no research on the use of acupuncture with conventional treatment in contrast to conventional treatment alone which would allow us to make specfic claims. From a Chinese medicine perspective, however, there are a number of ways in which treatment is pitched at systemic problems rather than unique symptoms themselves, and sometimes ways of making sense of a collection of disparate symptoms in a way which Western medicine might not recognise. There may well be some merit in asking the advice of a practitioner local to you about whether the way in which EDS presents in your particular case makes sense from a different medical perspective.

One caution for possible treatment, however, would be the tendency to bruise and the effect on wound healing. Acupuncture is a remarkably gentle treatment, with especially fine needles being used at relatively shallow levels, and only in severe cases of blood thinning through illness and medication is it contra-indicated. Any practitioner worth their salt will always treat conservatively in cases like yours to gauge how well the body responds to the physical process of treatment.

As far as the treatment of bipolar disorder is concerned, there isn't a great deal of evidence to suggest that acupuncture could be used reliably as a single intervention, and far too few trials of conventional medication with and without acupuncture to be able to offer a definitive view. A 2011 review of the use of complementary and alternative medicine in conjunction with conventional medication was encouraging but said what is almost always said - more and better reviews should be conducted.

A typical problem with the studies which have taken place is that, as this example below shows, the control treatment seems to have as positive results as the real one, and this usually leads to the dismissive remarks about treatment being no more than a placebo. This has a great deal to do with trial designs and the extreme difficulty of setting up a control which doesn't itself have an effect. As one of our medical colleagues once remarked, even if it were only a placebo it would be getting better results than using only the conventional treatment

The one caution, however, is that treating someone with bipolar disorder can often generate major issues about patient management. Although we are still working on standards for expert practice and have not as yet agreed the final standards which would allow a member to claim expertise in a field, mental health problems, along with paediatrics and obstetrics, are the first areas on which we are working. This recognises the fact that although the acupuncture which people use remains largely the same, the wider aspects of patient care for these groups often requires skills which are learned at postgraduate level. In the case of mental health problems, an inexperienced practitioner (and this simply means someone who hasn't dealt with many cases, not necessarily a recent graduate) could easily find themselves out of their depth.

In the case of either condition, therefore, we would always recommend that someone speaks face to face with a local BAcC member to get an idea of whether acupuncture treatment would be of specific benefit to them, and to a less extent, whether the practitioner felt competent to be able to offer useful help and treatment.

Q: Is there anything acupuncture could do for hypermobility as a whole body issue, rather than addressing the individual symptoms (primarily aches and pains in various parts of the body)?

A: A great deal depends on whether the hypermobility is a single issue within the body or whether it arises as one of a number of symptoms of a condition such as Ehler Danlos Syndrome on which we gave our advice a while ago as follows please click here

As a stand-alone condition, however, there are ways of understanding types of tissue, like muscle or bone, within Chinese medicine which are entirely different to the understanding of Western medicine. In terms of hypermobility of the joints the Chinese medicine practitioner might look, for example, at the functioning of the Liver and Gall Bladder which are said to be responsible for the condition and flexibility of the muscles and tendons of the body. Treating this part of the system is thought to influence all muscle and tendon in the body.

Note, though, how the Organs are capitalised to distinguish them from the western organs of the same name. The Chinese concept of an Organ is far wider than its western counterpart, and embraces a range of functions within body, mind, emotion and spirit. If a practitioner were to find other functional disturbances within these Organs which suggested an overall weakness, there may be a better possiblity that improving their efficiency, either directly or indirectly through treatment of the whole system, may have an effect on the condition from which you are suffering.

However, there is very little research to underpin any firm recommendations, and we have to tread very carefully to avoid claims that we are creating unreasonable expectations. Our position, however, is that Chinese medicine has been around for over 2000 years and has dealt and still deals with exactly the same reported symptoms as western medicine does today. Hypermoblity is not a 20th century phenomenon. As such, there have been many classifications of the way that it presents within the various differentiations of Chinese medicine, and with each classification, or syndrome, there is often a range of possible treatment suggestions. Even where a specific syndrome does not exist the essence of Chinese medicine is that if a system is in balance symptoms are said to resolve, and very early styles of treatment which remain popular today were largely asymptomatic, treating the person rather than the disease, as the saying goes.

The one note of caution is that conditions such as hypermoblity are not likely to resolve quickly, if they resolve at all, and it is very important to establish verifiable outcome measures to chart whether there has been any progress, and to ensure that if you go ahead with treatment your progress is carefully amd regularly reviewed. This will avoid any lack of clarity in results and expectation.

Our best advice remains, as always, to visit a BAcC member local to you to have a face to face assessment of whether acupuncture might be beneficial to you.

Q. Is there anything acupuncture could do for hypermobility as a whole body issue, rather than addressing the individual symptoms (primarily aches and pains in various parts of the body)?

A: great deal depends on whether the hypermobility is a single issue within the body or whether it arises as one of a number of symptoms of a condition such as Ehler Danlos Syndrome on which we gave our advice a while ago as follows: Please click here

As a stand-alone condition, however, there are ways of understanding types of tissue, like muscle or bone, within Chinese medicine which are entirely different to the understanding of Western medicine. In terms of hypermobility of the joints the Chinese medicine practitioner might look, for example, at the functioning of the Liver and Gall Bladder which are said to be responsible for the condition and flexibility of the muscles and tendons of the body. Treating this part of the system is thought to influence all muscle and tendon in the body.

Note, though, how the Organs are capitalised to distinguish them from the western organs of the same name. The Chinese concept of an Organ is far wider than its western counterpart, and embraces a range of functions within body, mind, emotion and spirit. If a practitioner were to find other functional disturbances within these Organs which suggested an overall weakness, there may be a better possiblity that improving their efficiency, either directly or indirectly through treatment of the whole system, may have an effect on the condition from which you are suffering.

However, there is very little research to underpin any firm recommendations, and we have to tread very carefully to avoid claims that we are creating unreasonable expectations. Our position, however, is that Chinese medicine has been around for over 2000 years and has dealt and still deals with exactly the same reported symptoms as western medicine does today. Hypermoblity is not a 20th century phenomenon. As such, there have been many classifications of the way that it presents within the various differentiations of Chinese medicine, and with each classification, or syndrome, there is often a range of possible treatment suggestions. Even where a specific syndrome does not exist the essence of Chinese medicine is that if a system is in balance symptoms are said to resolve, and very early styles of treatment which remain popular today were largely asymptomatic, treating the person rather than the disease, as the saying goes.

The one note of caution is that conditions such as hypermoblity are not likely to resolve quickly, if they resolve at all, and it is very important to establish verifiable outcome measures to chart whether there has been any progress, and to ensure that if you go ahead with treatment your progress is carefully amd regularly reviewed. This will avoid any lack of clarity in results and expectation.

Our best advice remains, as always, to visit a BAcC member local to you to have a face to face assessment of whether acupuncture might be beneficial to you.

Ehlers-Danlos Syndrome is one of a number of genetic connective tissue disorders which manifest in a wide array of symptoms and as congenital degenerative conditions are not likely to change or improve. In these circumstances the best that one could hope to achieve with acupuncture would be to relieve some of the symptoms which are manifesting your particular case, and perhaps to slow down the progressive deterioration.

There have been attempts to use acupuncture as part of a package of measures to help people deal with the condition, but no research on the use of acupuncture with conventional treatment in contrast to conventional treatment alone which would allow us to make specfic claims. From a Chinese medicine perspective, however, there are a number of ways in which treatment is pitched at systemic problems rather than unique symptoms themselves, and sometimes ways of making sense of a collection of disparate symptoms in a way which Western medicine might not recognise. There may well be some merit in asking the advice of a practitioner local to you about whether the way in which EDS presents in your particular case makes sense from a different medical perspective.

One caution for possible treatment, however, would be the tendency to bruise and the effect on wound healing. Acupuncture is a remarkably gentle treatment, with especially fine needles being used at relatively shallow levels, and only in severe cases of blood thinning through illness and medication is it contra-indicated. Any practitioner worth their salt will always treat conservatively in cases like yours to gauge how well the body responds to the physical process of treatment.

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